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Cns depressants
 

Cns depressants

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    Cns depressants Cns depressants Presentation Transcript

    • Central Nervous System Depressants
    • CNS Depressants
      • Sedatives
      • Drugs that have an inhibitory effect on the CNS to the degree that they reduce:
        • Nervousness
        • Excitability
        • Irritability
        • without causing sleep
    • CNS Depressants
      • Hypnotics
      • Calm or soothe the CNS to the point that they cause sleep
    • CNS Depressants
      • Sedative-Hypnotics—dose dependent:
      • At low doses, calm or soothe the CNS without inducing sleep
      • At high doses, calm or soothe the CNS
      • to the point of causing sleep
    • Sedative-Hypnotics: Barbiturates
      • First introduced in 1903, standard agents for insomnia and sedation
      • Habit-forming
      • Only a handful commonly used today due in part to the safety and efficacy of: BENZODIAZEPINES
    • Sedative-Hypnotics: Barbiturates
      • Four categories:
      • Ultrashort
        • mephobexital, thiamylal, thiopental
      • Short
        • pentobarbital, secobarbital
      • Intermediate
        • aprobarbital, butabarbital
      • Long
        • phenobarbital
    • Sedative-Hypnotics: Barbiturates
      • Barbiturates have a very narrow therapeutic index.
      • Therapeutic Index
      • Dosage range within which the drug is effective but above which is rapidly toxic.
    • Sedative-Hypnotics: Barbiturates
      • Mechanism of Action
      • Site of action:
        • Brain stem (reticular formation)
        • Cerebral cortex
      • By inhibiting GABA, nerve impulses traveling in the cerebral cortex are also inhibited.
    • Sedative-Hypnotics: Barbiturates
      • Drug Effects
      • Low doses: Sedative effects
      • High doses: Hypnotic effects (also lowers respiratory rate)
      • Notorious enzyme inducers
    • Sedative-Hypnotics: Barbiturates
      • Therapeutic Uses
      • Hypnotics
      • Sedatives
      • Anticonvulsants
      • Surgical procedures
    • Sedative-Hypnotics: Barbiturates
      • Side Effects
      • Body System Effects
      • CNS Drowsiness, lethargy, vertigo mental depression, coma
      • Respiratory Respiratory depression, apnea, bronchospasms, cough
    • Sedative-Hypnotics: Barbiturates
      • Side Effects
      • Body System Effects
      • GI Nausea, vomiting, diarrhea
      • Other Agranulocytosis, vasodilation, hypotension, Stevens-Johnson syndrome
    • Sedative-Hypnotics: Barbiturates
      • Toxicology
      • Overdose frequently leads to respiratory depression, and subsequently, respiratory arrest.
      • Can be therapeutic:
        • Anesthesia induction
        • Uncontrollable seizures: “phenobarbital coma”
    • Sedative-Hypnotics: Barbiturates
      • Drug Interactions
      • Additive effects:
        • ETOH, antihistamines, benzodiazepines, narcotics, tranquilizers
      • Inhibited metabolism:
        • MAOIs will prolong effects of barbiturates
      • Increased metabolism:
        • Reduces anticoagulant response, leading to possible clot formation
    • CNS Depressants: Benzodiazepines
      • Most frequently prescribed sedative-hypnotics
      • Most commonly prescribed drug classes
      • Favorable side effects
      • Efficacy
      • Safety
    • CNS Depressants: Benzodiazepines
      • Classified as either:
      • Sedative-hypnotic or Anxiolytic
      • (Medication that relieves anxiety)
    • CNS Depressants: Benzodiazepines
      • Sedative-Hypnotic Type
      • Long-Acting:
        • flurazepam (Dalmane), quazepam (Doral)
      • Short-Acting:
        • estazolam (Prosom), temazepam (Restoril),
        • triazolam (Halcion)
    • CNS Depressants: Benzodiazepines
      • Anxiolytic Type
      • alprazolam (Xanax)
      • chloridiazepoxide (Librium)
      • diazepam (Valium)
      • lorazepam (Ativan)
      • midazolam (Versed)
        • zolpidem (Ambien) and zaleplon (Sonata)
        • (nonbenzodiazepine hypnotic agents, share characteristics)
    • CNS Depressants: Benzodiazepines
      • Mechanism of Action
      • Depress CNS activity
      • Affect hypothalamic, thalamic, and limbic systems of the brain
      • Benzodiazepine receptors
    • CNS Depressants: Benzodiazepines
      • Drug Effects
      • Calming effect on the CNS
      • Useful in controlling agitation and anxiety
    • CNS Depressants: Benzodiazepines
      • Therapeutic Uses
      • Sedation
      • Sleep induction
      • Skeletal muscle relaxation
      • Anxiety relief
      • Treatment of alcohol withdrawal
      • Agitation
      • Depression
      • Epilepsy
      • Balanced anesthesia
    • CNS Depressants: Benzodiazepines
      • Side Effects
      • Mild and infrequent
      • Headache Drowsiness Dizziness Vertigo Lethargy Paradoxical excitement (nervousness) “Hangover effect”
    • CNS Depressants: Nursing Implications
      • Before beginning therapy, perform a thorough history regarding allergies, use of other medications,health history, and medical history.
      • Obtain baseline vital signs and I & O, including supine and erect BPs.
      • Assess for potential disorders or conditions that may be contraindications, and for potential drug interactions.
    • CNS Depressants: Nursing Implications
      • Give 15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep.
      • Most benzodiazepines (except flurazepam) cause REM rebound and a tired feeling the next day; use with caution in the elderly.
      • Patients should be instructed to avoid alcohol and other CNS depressants.
    • CNS Depressants: Nursing Implications
      • Check with physician before taking any other medications, including OTC medications.
      • It may take 2 to 3 weeks to notice improved sleep when taking barbiturates.
      • Abruptly stopping these medications, especially barbiturates, may cause rebound insomnia.
    • CNS Depressants: Nursing Implications
      • Safety is important
        • Keep side rails up
        • Do not permit smoking
        • Assist patient with ambulation (especially the elderly)
        • Keep call light within reach
      • Monitor for side effects
    • CNS Depressants: Nursing Implications
      • Monitor for therapeutic effects
        • Increased ability to sleep at night
        • Fewer awakenings
        • Shorter sleep induction time
        • Few side effects, such as hangover effects
        • Improved sense of well-being because of improved sleep